Caught between intending and doing: older people ideating on a self-chosen death
Els van Wijngaarden, Carlo Leget and Anne Goossensen (( University of Humanistic Studies, Utrecht, Netherlands))
The aim of this paper is to provide insight into what it means to live with the intention to end life at a self-chosen moment from an insider perspective.
Participants who lived independent or semidependent throughout the Netherlands.
25 Dutch older citizens (mean age of 82 years) participated. They were ideating on a self- chosen death because they considered their lives to be no longer worth living.
Inclusion criteria were that they:
- considered their lives to be ‘completed’;
- suffered from the prospect of living on;
- currently wished to die;
- were 70 years of age or older;
- were not terminally ill;
- considered themselves to be mentally competent;
- considered their death wish reasonable.
In this qualitative study, in-depth interviews were carried out in the participants’ everyday home environment (median lasting 1.56 h). Verbatim transcripts were analysed based on the principles of phenomenological thematic analysis.
The liminality or ‘in-betweenness’ of intending and actually performing self-directed death (or not) is characterised as a constant feeling of being torn explicated by the following pairs of themes:[pullquote]”I don’t want to die, but my life is simply unliveable.” [/pullquote]
- detachment and attachment;
- rational and nonrational considerations;
- taking control and lingering uncertainty;
- resisting interference and longing for support;
- legitimacy and illegitimacy.
Our findings show that the in-between period emerges as a considerable, existential challenge with both rational and non-rational concerns and thoughts, rather than a calculative, coherent sum of rational considerations. Our study highlights the need to take due consideration of all ambiguities and ambivalences present after a putatively rational decision has been made in order to develop careful policy and support for this particular group of older people
Strengths and limitations of this study
- This study gives voice to older people who wish to die — preferably with medical assistance —
although they do not suffer from a lifethreatening disease or a psychiatric disorder.
- This study is the first to elucidate what it means to live in-between intending and actually per-
forming a self-chosen act leading to death (or not).
- This study introduces empirical evidence into the largely theoretical debate on rational suicide.
- Our study highlights the need for due consideration of all ambiguities and ambivalences present after a putatively rational decision has been made, in order to develop careful policy and support for this particular group of older people.
- Although transferability to other countries is limited due to cultural differences, the Dutch discussion
may inform the debate on (legalisation of ) assisted dying in other Western countries.
- van Wijngaarden E, Leget C, Goossensen A. Caught between intending and doing: older people ideating on a self-chosen death. BMJ Open 2016;6:e009895. doi:10.1136/bmjopen-2015-009895
Photo credit: Simon & His Camera Life Is But A Walking Shadow – Syon Park London by Simon & His Camera via photopin (license)